{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:38:18Z","timestamp":1787726298989,"version":"build-2784847793"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T00:00:00Z","timestamp":1634083200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chain of Hope"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>As little is known about the prevalence and clinical progression of subclinical (latent) rheumatic heart disease (RHD) in sub-Saharan Africa, we report the results of a 5 year follow-up of a community based, echocardiographic study of the disease, originally carried out in a rural area around Jimma, Ethiopia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Individuals with evidence of RHD detected during the baseline study as well as controls and their family members were screened with a short questionnaire together with transthoracic echocardiography.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 56 individuals with RHD (37 definite and 19 borderline) in the original study, 36 (26 definite and 10 borderline) were successfully located 57.3 (range 44.9\u201370.7) months later. At follow-up two thirds of the definite cases still had definite disease; while a third had regressed. Approximately equal numbers of the borderline cases had progressed and regressed. Features of RHD had appeared in 5 of the 60 controls. There was an increased risk of RHD in the family relatives of borderline and definite cases (3.8 and 4.0 times respectively), notably among siblings. Compliance with penicillin prophylaxis was very poor.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>We show the persistence of echocardiographically demonstrable RHD in a rural sub-Saharan population. Both progression and regression of the disease were found; however, the majority of the individuals who had definite features of RHD had evidence of continuing RHD lesions five years later. There was an increased risk of RHD in the family relatives of borderline and definite cases, notably among siblings. The findings highlight the problems faced in addressing the problem of RHD in the rural areas of sub-Saharan Africa. They add to the evidence that community-based interventions for RHD will be required, together with appropriate ways of identifying active disease, achieving adequate penicillin prophylaxis and developing vaccines for primary prevention.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0009830","type":"journal-article","created":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T18:36:06Z","timestamp":1634150166000},"page":"e0009830","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Community-based prevalence of rheumatic heart disease in rural Ethiopia: Five-year follow-up"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3733-615X","authenticated-orcid":true,"given":"Tadesse","family":"Gemechu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6066-2765","authenticated-orcid":true,"given":"Eldryd H. O.","family":"Parry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdi H.","family":"Yacoub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David I. W.","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6473-2014","authenticated-orcid":true,"given":"Susy","family":"Kotit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,13]]},"reference":[{"key":"pntd.0009830.ref001","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1471-2261-14-28","article-title":"Rheumatic heart disease in Uganda: the association between MHC class II HLA DR alleles and disease: a case control study","volume":"14","author":"E Okello","year":"2014","journal-title":"BMC Cardiovasc Disord"},{"key":"pntd.0009830.ref002","doi-asserted-by":"crossref","first-page":"15084","DOI":"10.1038\/nrdp.2015.84","article-title":"Acute rheumatic fever and rheumatic heart disease","volume":"2","author":"JR Carapetis","year":"2016","journal-title":"Nature reviews Disease primers"},{"key":"pntd.0009830.ref003","first-page":"2047487316687104","article-title":"Community-based prevalence study of rheumatic heart disease in rural Ethiopia","author":"T Gemechu","year":"2017","journal-title":"Eur J Prev Cardiol"},{"issue":"5","key":"pntd.0009830.ref004","first-page":"297","article-title":"World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease\u2014an evidence-based guideline","volume":"9","author":"B Remenyi","year":"2012","journal-title":"NatRevCardiol"},{"key":"pntd.0009830.ref005","volume-title":"Practical statistics for medical research","author":"DG Altman","year":"1991"},{"issue":"2","key":"pntd.0009830.ref006","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1159\/000174993","article-title":"Rheumatic heart disease prevalence among schoolchildren of an Ethiopian rural town","volume":"80","author":"K Oli","year":"1992","journal-title":"Cardiology"},{"issue":"11","key":"pntd.0009830.ref007","first-page":"601","article-title":"Prevalence of rheumatic heart disease among school children in Addis Ababa","volume":"76","author":"K Oli","year":"1999","journal-title":"East AfrMed J"},{"issue":"17","key":"pntd.0009830.ref008","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1136\/heartjnl-2015-307444","article-title":"Prevalence of rheumatic heart disease in 4720 asymptomatic scholars from South Africa and Ethiopia","volume":"101","author":"ME Engel","year":"2015","journal-title":"Heart"},{"key":"pntd.0009830.ref009","doi-asserted-by":"crossref","first-page":"690227","DOI":"10.3389\/fcvm.2021.690227","article-title":"The \"Cairo Accord\"- Towards the Eradication of RHD: An Update","volume":"8","author":"S Kotit","year":"2021","journal-title":"Front Cardiovasc Med"},{"issue":"6","key":"pntd.0009830.ref010","doi-asserted-by":"crossref","first-page":"e0234196","DOI":"10.1371\/journal.pone.0234196","article-title":"Echocardiographic screening to determine progression of latent rheumatic heart disease in endemic areas: A systematic review and meta-analysis","volume":"15","author":"SJ Gutman","year":"2020","journal-title":"PloS one"},{"issue":"2","key":"pntd.0009830.ref011","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2174\/1573403X13666170116120828","article-title":"Adherence to Secondary Prophylaxis for Acute Rheumatic Fever and Rheumatic Heart Disease: A Systematic Review","volume":"13","author":"PM Kevat","year":"2017","journal-title":"Curr Cardiol Rev"},{"issue":"1","key":"pntd.0009830.ref012","article-title":"\u201cTowards developing a vaccine for rheumatic heart disease,\u201d","volume":"2017","author":"G. D Gandhi","year":"2017","journal-title":"Glob. Cardiol. Sci. Pract."},{"issue":"7","key":"pntd.0009830.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pntd.0007511","article-title":"\u201cConcerns for efficacy of a 30-valent M-protein-based Streptococcus pyogenes vaccine in regions with high rates of rheumatic heart disease,\u201d","volume":"13","author":"P. M Giffard","year":"2019","journal-title":"PLoS Negl. Trop. 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